JP2008545479A - Electromagnetic energy emitting device with increased spot size - Google Patents

Abstract

  The outputs of the plurality of electromagnetic energy emitting devices are integrated to produce integrated electromagnetic energy. The integrated electromagnetic energy illuminates the target with a spot size that is larger than the spot size acquired by a single electromagnetic energy emitting device.

Description

  The present invention relates generally to electromagnetic energy emitting devices, and more specifically to medical lasers.

Various electromagnetic energy generating device configurations exist in the prior art. For example, solid state laser systems generally include a laser rod for emitting coherent light and a source for directing the laser rod to emit coherent light. Coherent light, which can be referred to as a laser beam, can be delivered to the target surface through an optical fiber waveguide. Care must be taken to ensure that the laser beam has properties suitable for the performance of the intended function. For example, the characteristics of a laser beam employed to cut or remove dental tissue can be different from the characteristics of a laser beam employed to coagulate soft tissue blood. A laser beam can be described by its fluence or power density, which can then be measured, for example, in watts per square meter (W / m ² ), milliwatts per square centimeter (mW / cm ² ), etc. . By convention, preferred values for fluence or power density levels have been determined, depending on the procedure being performed.

  Patient comfort can be an important consideration, for example, in the use of medical laser devices applied to teeth. Critical aspects of patient comfort can include the amount of time required to perform a dental treatment. In general, a short treatment time may be preferable compared to a long possession time. In some cases, the treatment time can be reduced by increasing the fluence or power density level of the laser beam. For example, fluence or power density can be increased by increasing the power of the laser beam. However, increasing the output may create an unpleasant odor that reduces patient comfort. In addition, higher fluence or power density levels may result in higher temperatures associated with the procedure, which may increase pain in the patient or reduce the quality of the outcome of the procedure.

  In the prior art, there is a need to increase the laser power delivered to the treatment area without increasing the fluence or power density of the laser beam.

  The present invention addresses this need by providing a method for increasing the size of an area of interest (e.g., spot size), where the area of interest (e.g., tooth-like) N) Irradiated with electromagnetic energy on the target. Implementation of the disclosed method herein includes providing a reference area on the target so that the reference electromagnetic energy emitting device can irradiate the reference area with therapeutic electromagnetic energy having a reference power density. The therapeutic electromagnetic energy can have a wavelength suitable for treating (eg, ablating) a reference area that can include, for example, dental caries. Once this reference is established, the implementation further provides a plurality of electromagnetic energy emitting devices that can irradiate the reference area with therapeutic electromagnetic energy having a reference power density. The therapeutic electromagnetic energy emitted by the plurality of electromagnetic energy emitting devices is integrated to produce integrated electromagnetic energy that is directed to the target. According to the illustrated implementation, the area of interest is illuminated by integrated electromagnetic energy having a power density that is greater than the reference area and substantially equal to the reference power density.

  The present invention further discloses an apparatus for increasing the size of an area of interest on a target irradiated by electromagnetic energy. Embodiments of this device integrate a plurality of electromagnetic energy emitting devices capable of irradiating a reference area with therapeutic electromagnetic energy having a reference power density and therapeutic electromagnetic energy emitted by the plurality of electromagnetic energy emitting devices, And an integrated device capable of generating integrated electromagnetic energy. Another embodiment of the invention includes a medical laser device that includes a plurality of lasers capable of generating a treatment laser beam that illuminates a reference area on a target with a reference power density. The treatment laser beam can have a wavelength suitable for treating (eg, ablating) a reference area that can include, for example, dental caries. This embodiment further includes an integrated device that can integrate the treatment laser beams generated by the plurality of lasers to generate at least one integrated laser beam.

  Any feature or combination of features described herein is not intended to be inconsistent with the features contained in any such combination, unless the features, specification, and knowledge of those skilled in the art are clear from one another. Included within the scope of the invention. For purposes of summarizing the invention, certain aspects, advantages, and novel features of the invention are described herein. Of course, all such aspects, advantages, or features may be embodied in any particular embodiment of the invention. Additional advantages and aspects of the present invention are apparent in the following detailed description and claims.

  Reference will now be made in detail to the presently preferred embodiments of the invention, examples of which are illustrated in the accompanying drawings. Wherever possible, the same or similar numbers are used in the drawings and the description to refer to the same or like parts. The drawings are in simplified form and are not to scale. Referring to the feelings herein, for example, top, bottom, left, right, top, bottom, top, top, bottom, bottom, back, front, for convenience and clarity purposes only. Note that such directional terms are used with reference to the accompanying drawings. Terms indicating such directionality should not be construed as limiting the scope of the invention in any way.

  While the disclosure herein refers to particular embodiments, it is to be understood that these embodiments are presented by way of example and not limitation. The intent of the following detailed description is to illustrate exemplary embodiments, but all modifications to the embodiments, alternative approaches, which may fall within the spirit and scope of the invention as defined by the claims, And the equivalent. It will be understood and appreciated that the process steps and structures described herein do not cover the complete process flow of manufacturing and operation of an electromagnetic energy generation device. The present invention can be implemented in connection with various laser device fabrication and operation methods commonly used in the art, with only the generally performed process steps necessary to provide an understanding of the present invention. Included in this specification. This specification has applicability in the field of general electromagnetic energy generation devices and processes. However, for illustrative purposes, the following description relates to a medical laser apparatus and method for increasing the spot size of a medical laser.

  The present invention relates to an electromagnetic energy emitting device, such as a laser, for treating tissue. Certain electromagnetic energy emitting devices that can be used in connection with or in combination with the present invention include, for example, relatively high power erbium type lasers such as tissue ablating lasers and wavelengths that are relatively highly absorbed by water, for example. Including other lasers. An example of a laser configuration (e.g., a configuration including fluid components and applications) and method was filed on Jan. 10, 2006 and is entitled US Patent Application Serial No. 11/330 entitled FLUID CONDITIONING SYSTEM (Attorney Docket No. BI9914P). , 388, filed Jan. 10, 2005, US Patent Application No. 11 / 033,032 dated ELECTROMAGNETIC ENERGY DISTRIBUTIONS FOR ELECTROMAGNETICALLY INDUCTED DISCUTING (Attorney Docket No. BI9842P) Named LASER HANDPICE ARCHITECTURE AND METHODS (attorney reference number BI9806P) US patent application Ser. No. 11 / 203,677 and US patent application Ser. No. 11 / filed on August 12, 2005 and entitled DUAL PULSE-WIDTH MEDICAL LASER WITH PRESETS (Attorney Docket Number BI9808P). No. 203,400, the entire contents of all of which are hereby incorporated by reference.

Referring more specifically to the drawings, FIG. 1 is a block diagram of a prior art electromagnetic energy emitting device that can be, for example, a medical laser device. The illustrated embodiment includes an electromagnetic energy source 100 that can be, for example, a medical laser. An electromagnetic energy source 100 coupled to a waveguide 105 having a reference cross-sectional area can generate a reference output level of electromagnetic energy that is directed to a target, such as a target surface. Can be directed. For example, laser beam 110 is emitted from the output of waveguide 105 and is directed to spot 115 on the target surface, which spot 115 has a reference area associated with reference diameter 120. Spot 115 can represent an area of interest that is illuminated by electromagnetic energy on the target surface. The electromagnetic energy can irradiate an area of interest on the target surface, for example, with a reference fluence or power density measured in milliwatts per square centimeter (mW / cm ² ). The prior art configuration shown in FIG. 1 is referred to herein as a pre-configured electromagnetic energy emitting device, where the term “pre-configuration” means that it is not configured according to the present invention. Or, for example, is meant to mean that it is not configured as part of an integrated output system. Thus, the prior art arrangement provides a basis by which the present invention can be compared. That is, the configuration of the prior art shown in FIG. 1 determines the reference output level of the electromagnetic energy source, the reference cross section of the waveguide, the reference fluence or output density of the electromagnetic energy that irradiates a spot having a reference area on the target surface provide. The reference fluence or power density does not have an increased diameter to simultaneously accept therapeutic (eg, ablation) energy from multiple electromagnetic energy emitting devices in a similar procedure, and any other electromagnetic energy emitting device. Can correspond to the reference fluence or power density of a single electromagnetic energy emitting device that outputs therapeutic (eg, ablation) energy to a single waveguide that also does not carry therapeutic (eg, ablation) energy from the In certain cases, the diameter of the waveguide is at the interior or output of the reference waveguide from one of the electromagnetic energy emitting devices performing the treatment in a separate or non-integrated mode of operation. A fluence or power density can be selected that is measured or provided at the interior or output of the waveguide, corresponding to or equal to the reference fluence or power density used in the procedure, respectively.

  As used herein, the therapeutic output from an electromagnetic energy emitting device is, for example, an implementation where the number of waveguides that receive the therapeutic energy output from the electromagnetic energy emitting device is equal to the number of electromagnetic energy emitting devices. Electromagnetics that are not integrated or combined together, do not have the same wavelength, and / or do not have the same therapeutic function (eg, one is a coagulation function and one ablation function) Corresponds to the use of energy release device.

  According to aspects of the present invention, therapeutic energy outputs from a plurality of electromagnetic energy emitting devices may be combined or integrated into a waveguide (eg, one optical fiber and / or output tip), Alternatively, it may be combined or integrated into a relatively small number of waveguides compared to the number of electromagnetic energy emitting devices. For example, an integrated output system according to the present invention provides therapeutic energy output from two electromagnetic energy emitting devices (such as the same electromagnetic energy emitting device such as the same laser) integrated into a single waveguide. Can be included. As provided herein, for example, in the context of treatment energy, the term treatment used as treatment energy treatment electromagnetic energy, treatment beam, or treatment output refers to the target (eg, all for cutting or for coagulation. Refers to energy, beam, or output, all performed at substantially the same function.

  The drawing of FIG. 2 shows, for example, one embodiment of an electromagnetic energy emitting device with increased spot size according to the present invention. The illustrated embodiment includes first and second electromagnetic energy sources indicated by reference numerals 140 and 145, respectively, which can be, for example, medical lasers. The first electromagnetic energy source 140 generates therapeutic electromagnetic energy (eg, a tissue ablation laser beam) at a reference power level and is coupled to the first waveguide 150, and in the illustrated embodiment, the waveguide of FIG. Having a cross-sectional area equal to the reference cross-sectional area described above with respect to 105. Similarly, the second electromagnetic energy source 145 generates therapeutic electromagnetic energy at a reference power level and is coupled to the second waveguide 155 and similarly has a cross-sectional area equal to the reference cross-sectional area. The first and second electromagnetic energy is distinct from treating (eg, just irradiating) a reference area that can include, for example, hard tissue (eg, teeth) or soft tissue (eg, gingiva). A wavelength suitable for ablation.

  The first waveguide 150 and the second waveguide 155 are integrated in an integrated device 160 symbolized by the phantom box in FIG. The therapeutic electromagnetic energy entering the integrated device 160 through the first waveguide 150 and the second waveguide is a reference cross-sectional area (eg, as large as 1.1 or more times as twice the reference area). The integrated device 160 exits through a third waveguide 165 having a substantially larger cross-sectional area. The integrated electromagnetic energy 170 exits the third waveguide and illuminates a spot 170 that includes an area of interest on the target, such as the target surface. The spot 175 can have a diameter 180 that is larger than the reference diameter 120 (FIG. 1). According to an exemplary embodiment, the diameter 180 is about 1.414 times the reference diameter.

  A modified embodiment of the invention is shown in the block diagram of FIG. The illustrated embodiment includes first and second electromagnetic energy sources 200 and 205 that emit therapeutic electromagnetic energy at a reference power level, where the therapeutic electromagnetic energy is coupled to waveguides 220 and 225, respectively. Waveguides 220 and 225 can be flexible, each of which can direct therapeutic electromagnetic energy to a target, such as a target surface. In the example shown in FIG. 3, the first waveguide 220 directs therapeutic electromagnetic energy 230 onto the target surface. Similarly, the second waveguide 225 directs therapeutic electromagnetic energy 235 onto the same target surface. The therapeutic electromagnetic energy 230 and 235 thus forms an integrated electromagnetic energy at the target surface. The integrated electromagnetic energy can illuminate the spot 240, the area of interest, which can be substantially larger (eg, by 1.1 to 2 times) than the reference area. The fluence or power density of the integrated electromagnetic energy is substantially equal to the reference fluence or power density, considering that the integrated electromagnetic energy is about twice the reference power and is distributed over about twice the reference area. The same can be done.

  Those skilled in the art will recognize additional embodiments of the present invention in view of the examples already presented. In general, the therapeutic energy outputs of any number of electromagnetic energy sources are integrated with each other so that the electromagnetic energy having a fluence or power density substantially the same as the reference power density has an area larger than the reference area, such as a spot An integrated output electromagnetic energy emitting device can be formed that can illuminate the area of interest. For example, the embodiment shown in FIG. 4 can include multiple (eg, three, four, five or more) electromagnetic energy sources. In the embodiment shown in FIG. 4, five such electromagnetic energy sources 260, 265, 270, and 280 generate therapeutic electromagnetic energy at a reference output level. The generated therapeutic electromagnetic energy is coupled to respective waveguides 285, 290, 295, 300, and 305 having a cross-sectional area equal to the reference cross-sectional area, according to an exemplary embodiment. The therapeutic electromagnetic energy from waveguides 285, 290, 295, 300, and 305 is coupled to an electromagnetic energy integrating device 310 having five therapeutic energy inputs and two outputs.

  The two outputs couple electromagnetic energy (eg, therapeutic electromagnetic energy) to first and second output waveguides 315 and 320 that have an electrical area that is larger than a reference cross-sectional area. For example, the first and second output waveguides 315 and 320 can have a cross-sectional area equal to about 5/2 of the reference cross-sectional area. In a manner similar to that described above in the description of FIG. 3, the first and second output waveguides 315 and 320 are electromagnetic (eg, therapeutic electromagnetic energy) emitted from the electromagnetic energy integrating device 310. At least part of the energy can be directed to the goal. That is, the first output waveguide 315 can direct the first beam 325 of electromagnetic energy to the target, and the second output waveguide 320 can direct the second beam 330 of electromagnetic energy to the target. The configuration just described has the effect of integrating therapeutic electromagnetic energy from five electromagnetic energy sources at the spot 335 on the target. In some embodiments, the integration can occur on or within the target surface. The spot 335, which can be referred to as the area of interest, can have an area that is approximately five times the reference area in the illustrated embodiment.

  A modification of the embodiment shown in FIG. 4 is a single output waveguide (eg, a first output) that directs integrated electromagnetic energy corresponding to (eg, includes) the first beam 325 and the second beam 330 (eg, a first output). A waveguide 315). In another modified embodiment, the output from the electromagnetic energy emitting device (e.g., defining an integrated output system and / or forming an increased fluence or increased output) is Without using the wave tube and / or electromagnetic energy integrating device 310, they are combined or integrated with each other on or within the target using optical components such as lenses and / or reflective surfaces. The output from the electromagnetic energy emitting device of another modified embodiment (e.g., defining an integrated output system and / or forming an enhanced fluence or enhanced output) is the waveguide And / or by using optical components such as lenses and / or reflective surfaces without using the electromagnetic energy integration device 310, and then directed to the target (eg, without using a waveguide, the lens And / or using optical components such as reflective surfaces), combined or integrated.

  FIG. 5A shows two possible parts of a device that can be integrated, and in this example, shows two therapeutic electromagnetic energy beams of energy. The embodiment shown in FIG. 5A includes a first electromagnetic energy source 350 and a second electromagnetic energy source. The therapeutic electromagnetic energy from the first electromagnetic energy source 350 is emitted at a reference power level and is directed to a first waveguide 360 having a reference cross-sectional area. Similarly, therapeutic electromagnetic energy from the second electromagnetic energy source 355 is also emitted at a reference power level and directed to a second waveguide 365 having a reference cross-sectional area. The therapeutic electromagnetic energy 370 that can form a beam at the output of the first waveguide 360 redirects the therapeutic electromagnetic energy 370 to a beam 390 that can illuminate a portion of the spot 400 on the target surface. Directed to a convex lens 375 that can act as such. At the same time, the therapeutic electromagnetic energy 380 that can form a beam at the output of the second waveguide 365 is applied to the beam 395 that can also irradiate the therapeutic electromagnetic energy 380 to a portion of the spot 400 on the target surface. It is directed to a reflective surface such as a mirror 385 that can act to change direction. Beam 390 and beam 395 are thus integrated at the target surface to form integrated electromagnetic energy. According to a typical example, the spot 400 can have, for example, an area that is approximately twice the reference area, and the fluence or power density of the integrated electromagnetic energy is approximately the same as the reference power density.

  Another embodiment of the present invention is shown in FIG. 5B where therapeutic electromagnetic energy from two or more (eg, four) electromagnetic energy sources is integrated. The illustrated embodiment shows the first, second, third, and fourth beams at the output of each of the first, second, third, and fourth waveguides 820, 825, 830, and 835. Each of first, second, third, and fourth electromagnetic energy sources 800, 805, 810, and 815 forming 840, 845, 850, and 855, respectively. The first, second, third, and fourth waveguides 820, 825, 830, and 835 can have a reference cross-sectional area, and the electromagnetic energy sources 800, 805, 810, and 815 can have a reference fluence or output. A therapeutic electromagnetic energy having a density can be generated. The first electromagnetic energy source 800, ie, the therapeutic electromagnetic energy generated by the first beam 840, has a first branch (eg, reflection) having a branch (eg, reflection) surface that directs at least a portion of the first beam 840 toward the optical component 885. Directed to device 860. The first beam can be directed through any one or more of the second, third, and fourth reflectors 865, 870, 875, although in modified embodiments these are It is not necessary to be directed through, thus forming part of an integrated beam 880 of therapeutic electromagnetic energy that impinges on the optical component 885. Each of the second, third, and fourth branch (eg, reflection) devices 865, 870, and 875 can be configured similarly to the branch device 860.

  Thus, for example, in embodiments where one or more of the optical paths from the first, second, third, and fourth branching devices 860, 865, 870, and 875 overlap, the second, third, and As shown in FIG. 5B, any one or more of the fourth branching devices 865, 870, and 875 may be used to direct at least a portion of the therapeutic electromagnetic energy (eg, the reflected portion of the first beam) directed downward. Can be configured to be sent to the optical component 885. The therapeutic electromagnetic energy generated by the second electromagnetic energy source 805, i.e., the second beam 845, can be directed to the second branching device 865, which similarly directs at least a portion of the second beam 845, e.g. Through the tri-branch device 870 and the fourth bifurcation device 875, it has a reflective surface that faces in the direction of the optical component 885 and can thus form an additional part of the integrated beam 880 of electromagnetic energy. Similarly, the therapeutic electromagnetic energy generated by the third and fourth electromagnetic energy sources 810 and 815, i.e., the third and fourth beams 850 and 855, is at least part of the third and fourth beams 850 and 855. Can be directed in the direction of the third and fourth branching devices 870 and 875, which can be directed in the direction of the optical component 885, thus forming yet another additional portion of the integrated beam 880. .

  The optical component 885 shown in FIG. 5B can direct the integrated beam 880 of therapeutic electromagnetic energy to a typical convex lens, or a waveguide 890 having a cross-sectional area that can be, for example, larger than a reference cross-sectional area. Similar structures can be included. Typically, the integrated beam 880 exits the waveguide 890 at the flat output end 895 and is therefore larger than the reference spot size and the reference fluence or power density is the same or substantially the same on the target. Generate a spot size.

  FIG. 5C shows an embodiment similar to that shown in FIG. 5B, for example, with a modified optical component 86 corresponding to optical component 885 capable of directing integrated beam 880 to waveguide 891 having a reference cross-sectional area. A part of The material used to form a modern waveguide (eg, waveguide 891) can typically deliver an integrated beam 880 of electromagnetic energy having an output that is higher than the reference output. In the illustrated embodiment, the integrated beam 880 is expanded through the defocusing optics 896 that can expand the integrated beam 880 to produce an increased spot size on the target as described herein. Exit the waveguide 891.

  In accordance with the present invention, any one or more of a pre-configured electromagnetic energy emitting device that forms a relatively large spot size and a relatively constant (eg, unchanging) fluence or power density, eg, an integrated power system. An integrated output system is provided having a fluence or power density corresponding to the above. In typical implementations, the output fluence or power density of the integrated output system is such that any one or more individual fluences or therapeutic electromagnetic energies of the individual electromagnetic energy emitting devices that form the integrated output system or It is almost the same as the power density.

  Aspects of the invention include a method for increasing the size of an area of interest, where the area of interest is on a target, such as a target surface, and is illuminated by electromagnetic energy. FIG. 6 shows the implementation of the method, where a reference area is prepared in step 410. An example of a reference area is shown in FIG. 1, and a spot 115 that can represent the reference area is illuminated by electromagnetic energy from an electromagnetic energy source 100 that supplies electromagnetic energy at a reference output level. In the illustrated example, therefore, the reference area is illuminated by electromagnetic energy having a reference fluence or power density.

  Implementation of the method shown in FIG. 6 continues at step 420 by providing a plurality of electromagnetic energy emitting devices that can irradiate a reference area with therapeutic electromagnetic energy having a reference fluence or power density. Examples of preparation are described above in the description with respect to FIGS. For example, two electromagnetic energy emitting devices are provided in the embodiment shown in FIGS. 2, 3, and 5 and five such devices are provided in FIG. The therapeutic electromagnetic energy emitted by the prepared electromagnetic energy emitting device is integrated in implementation step 430, thus producing integrated electromagnetic energy.

  Several types of devices that can integrate the emitted electromagnetic energy are shown herein. For example, FIG. 2 shows that directing electromagnetic energy to first and second waveguides 150 and 155 having a reference cross-sectional area and directing electromagnetic energy to a third conductor having a cross-sectional area greater than the reference cross-sectional area. An integrated device 160 is shown in which electromagnetic energy is integrated by exiting the integrated device through a wave tube 165. In the illustrated embodiment, the larger cross-sectional area may be about 1.1 or more times larger, for example, twice the reference cross-sectional area. Another implementation of the method for integrating electromagnetic energy can be performed by the apparatus shown in FIG. Integration in the illustrated example occurs at a target surface onto which therapeutic electromagnetic energy from electromagnetic energy sources 200 and 205 is directed. The embodiment shown in FIG. 5A shows yet another apparatus that can implement the integration of step 430. In the embodiment of FIG. 5A, the integration is again at the target surface after the beams of electromagnetic energy 370 and 380 are redirected by the convex lens 375 and mirror 385 to irradiate the spot 400 on the target surface, respectively. The area of the spot 400 that is achieved is, for example, approximately twice the reference area, and the fluence or power density of the electromagnetic energy (ie, integrated electromagnetic energy) that irradiates the spot 400 is approximately the same as the reference power density. be able to. In a modified embodiment, the convex lens can replace the mirror 385 in the embodiment shown in FIG. 5A. In yet another modified embodiment, the mirror can replace the convex lens 375. Other combinations of electromagnetic energy integration methods are described above with respect to FIG.

  In embodiments in which outputs from multiple electromagnetic energy emitting devices are directed to the same waveguide, the diameter of the waveguide is typically a reduced number of therapeutic outputs from multiple electromagnetic energy emitting devices (eg, (Which is less than the number of electromagnetic energy emitting devices) can be selected to give a fluence or power density corresponding to what is produced without being combined. For example, the diameter of the waveguide carrying the integrated therapy beam of the integrated power system is selected to provide approximately the same fluence or power density as the reference fluence or power density typical or suitable for the procedure being performed (eg, In accordance with aspects of the present invention, the therapeutic output of multiple electromagnetic energy emitting devices can be integrated to provide a larger spot size for the same approximate fluence or power density. For the performance of a given procedure, the waveguide diameter is the electromagnetic at which the procedure outputs therapeutic energy to a single waveguide (eg, as in normal or non-integrated mode of operation). When implemented using one of the energy emitting devices, one of ordinary skill in the art will select to produce a fluence or power density that is approximately the same as the reference fluence or power density that is perceived as suitable for treatment performance. Can do. According to another aspect, for a given treatment performance, the waveguide diameter for carrying an integrated beam in an integrated output system outputs therapeutic energy to a single waveguide, Produced by one of the electromagnetic energy emitting devices (of the integrated output system) operating at the same settings used by the electromagnetic energy emitting device when operated as part of the integrated output system during the procedure One can choose to produce a fluence or power density that is approximately the same as the reference fluence or power density.

  Returning to FIG. 6, at step 440, integrated electromagnetic energy is directed at a target, such as a target surface. According to some embodiments, the integration of therapeutic electromagnetic energy occurs at the target surface, as shown in the examples shown in FIGS. In other cases, the integration occurs in an integration device from which integration energy is directed to the target surface. An exemplary integrated device implementation is shown in FIG. 2, where electromagnetic energy is integrated in a waveguide and / or integrated device, as described herein. In other embodiments, integration can be achieved by employing optical components that can include lenses and / or reflective surfaces. Some embodiments (see FIG. 2) may employ one or more waveguides to direct the integrated electromagnetic energy to the target surface, while other embodiments (see FIG. 5A) (See) can direct the integrated electromagnetic energy to the target surface without the use of a waveguide.

  Generating a relatively large spot size using an integrated output system according to the present invention can allow, for example, more of a target (eg, tissue) to be removed per unit time. In an exemplary embodiment, an integrated output system is provided, at least in part, by combining and / or integrating outputs from multiple electromagnetic energy emitting devices (eg, laser heads) with each other, and thus enhancing Produces an output with a given fluence or enhanced output, which can then be directed through a waveguide system that includes fewer waveguides than the number of electromagnetic energy emitting devices.

  Implementations of the present invention may include (1) any of the previously configured electromagnetic energy emitting devices described herein or incorporated by reference, and / or (2) any other previously configured electromagnetic energy emitting device, To form a combination or permutation of the spot size, fluence, and / or fluence and / or fluence that does not substantially change relative to the power density or Providing an integrated output system having power density can be included.

  In one modified embodiment of the invention where not all of the therapeutic output, beam, or energy is the same in function or wavelength, the outputs of the various electromagnetic energy emitting devices are integrated into a reduced number of waveguides. Leaving the fluence or power density substantially unchanged can be implemented to combine the characteristics of the individual electromagnetic energy emitting devices into a single simultaneous effect on the target surface. For example, one such modified configuration can employ a combination of a first beam having a tissue cutting wavelength and a second beam having a clotting wavelength that can enhance blood clotting.

  In another modified embodiment according to one of many possible implementations, it can be referred to as an A wavelength that ranges from about 2.70 to 2.80 microns (eg, about 2.78 microns). One or more erbium, chromium, yttrium, scandium, gallium, garnet (Er, Cr: YSGG) solid state lasers having a wavelength can be referred to as a B wavelength of, for example, about 2.69 microns. It can be combined with one or more chromium, thulium, erbium, yttrium, aluminum garnet (CTE: YAG) solid state lasers. In another modified implementation, one or more erbium, yttrium, aluminum garnet Er. Having a wavelength that can be referred to as a C wavelength of about 2.94 microns. A YAG solid state laser can be combined with, for example, one or more chromium, thulium, erbium, yttrium, aluminum garnet (CTE: YAG) solid state lasers having a wavelength of about 2.69 microns.

  In embodiments where the electromagnetic energy emitting device includes a laser, multiple laser cavities can be provided. The number of laser cavities can correspond, for example, to the number of lasers used. Any of the electromagnetic energy emitting devices described herein or incorporated by reference and / or various combinations and substitutions of other electromagnetic energy emitting devices may be integrated, for example, unchanged fluence or power density and Output (ie, integrated output) energy distribution with increased spot size can be provided. In accordance with one aspect of the present invention, electromagnetic energy emitting devices having the same or substantially the same wavelength are combined to have the same fluence as the previous combination (e.g., as in a normal or non-integrated mode of operation) or An output energy distribution of increased spot size can be provided, although at power density.

  The present invention is incorporated herein by reference, for example, with the title CONTRA-ANGLE ROTATING HANDPICE HAVING TACTILE-FEEDBACK TIP FERRULE (Attorney Docket No. BI798P) filed July 20, 2005. It can be applied to various electromagnetic energy emitting device configurations and methods as disclosed in connection with the identification connector described in pending US Patent Application Serial No. 11 / 186,619. Referring to FIG. 7, a delivery system that can deliver electromagnetic energy, such as laser energy, to a treatment site is shown. The illustrated embodiment includes a laser handpiece 520 that uses a link element 525 to connect to an electromagnetic energy source housed within, for example, a laser base unit 530. According to an exemplary embodiment, the laser base unit 530 can include a plurality of electromagnetic energy sources (eg, lasers) that generate therapeutic electromagnetic energy at a reference power level. The therapeutic electromagnetic energy emitted by the electromagnetic energy source can be integrated and coupled to the link element 525. Link element 5252 includes one or more optical fibers capable of carrying therapeutic and / or integrated electromagnetic energy as described herein, a tube for air, a tube for water, and the like. be able to. The link element 525 can further include a connector 540 that joins the conduit 535 to the laser base unit 530. Connector 540 is a pending US patent application entitled IDENTIAL CONNECTOR FOR A MEDICAL LASER HANDPICE filed July 27, 2005, the contents of which are incorporated herein by reference. The identification connector can be fully described by reference number 11 / 192,334. For example, the identification connector can allow recognition of whether a relatively large spot size of electromagnetic energy (such as an integrated output) or a standard spot size is output. Can do. The laser handpiece 520 can include an elongate portion 522 and a handpiece tip 545, which can be connected to or include the same plurality of optical fibers as the optical fibers contained in the conduit 535. Can be arranged. Proximal (ie, relatively close to laser base unit 530) portion 521 and distal (ie, relatively far from laser base unit 530) portion 550 are the proximal and distal ends of laser handpiece 520. Each can be arranged. The distal portion 550 has a fiber tip 555 protruding therefrom, which will be described in more detail below with respect to FIG. As shown, the link element 525 has a first end 526 and a second end 527. The first end 526 is coupled to the receiving portion 532 of the laser base unit 530, and the second end 527 is coupled to the proximal portion 521 of the laser handpiece 520. The connector 540 can be mechanically connected to the laser base unit 530 by screw connection to a receiving portion 532 that forms part of the laser base unit 530.

  An embodiment of the connector 540 is shown in detail in FIG. The illustrated embodiment includes a laser beam delivery guide connection 560 that can include, for example, a treatment optical fiber 565 that can deliver laser energy to the laser handpiece 520 (FIG. 7). According to the embodiments described herein, the treatment optical fiber 565 is disposed within the laser housing 530 and integrated electromagnetic (eg, laser) energy from a plurality of electromagnetic energy sources coupled to the treatment optical fiber 565. Can accommodate a larger cross-sectional area than is normally employed in such devices. The illustrated embodiment further includes a plurality of ancillary connections, in this example a feedback connection 615 that can be connected to the laser unit 530 (FIG. 7), an illumination light connection 600, an atomizing air connection. 595 and spray water connection 590. The plurality of accessory connections can further include connections that are not visible in FIG. 8, such as excitation light connections and cooling air connections.

  The embodiment of the connector 540 shown in FIG. 8 further includes a threaded portion 570 that can be mated, thus providing a connection to a receiver 532 on the laser base unit 530 (FIG. 7).

  FIG. 9 shows a module that can be connected, can form part of an electromagnetic energy source (eg, laser base unit 530 shown in FIG. 7), and can accept a connector (FIG. 8). It is a perspective view of an embodiment. The illustrated embodiment includes a plate 575 that can be attached to the laser base unit 530 (FIG. 7) using, for example, a screw inserted into the hole 576. The module includes a receptacle 532 that can be threaded onto the inner surface 580 to mate with a screw 570 on the connector 540 (FIG. 8). (The screw is not shown in FIG. 9.) The module embodiment further includes a laser energy coupling 561 fitted into the laser beam delivery guide connection 560 (FIG. 8), which laser energy coupling 561. Can provide laser energy to the delivery system. This embodiment further includes a plurality of additional couplings including a spray air coupling 596, a spray water coupling 591, a cooling air coupling 611, and an excitation light coupling 606. The embodiment further includes a feedback coupling portion and an irradiation light coupling portion that are not visible in the figure. One or more key slots 585 can be included to ensure that the connector 540 connects to the receptacle 532 in the correct orientation.

  FIG. 10 is a front view of the embodiment of the module shown in FIG. The diagram of FIG. 10 shows a plate 575 and holes 576 that can be used to secure the plate module to an electromagnetic energy source such as the laser base unit 530 shown in FIG. Further, a laser energy coupling unit 561, a feedback coupling unit 616, an irradiation light coupling unit 601, a spray air coupling unit 596, a spray water coupling unit 591, a cooling air coupling unit 611, and an excitation light coupling unit 606 are shown. During operation, the spray water coupling portion 591 can engage with the spray water connection portion 590 in the connector 540 (FIG. 8) and supply spray water to the spray water connection portion. Similarly, the atomizing air coupling portion 596 can be fitted into the atomizing air connecting portion 595 in the connector 540 and supply the atomizing air to the atomizing air connecting portion. Furthermore, the irradiation light coupling unit 601, the excitation light coupling unit 606, and the cooling air coupling unit 611 can be fitted to the irradiation light connection unit 600 in the connector 540 to supply irradiation light. The pumping light can be supplied by fitting to a cooling air connection (not shown) and the cooling air can be supplied. Further, the feedback coupling 616 can mate with and receive feedback from the feedback connection 615 in the connector 540. According to the illustrated embodiment, the irradiation light coupling unit 601 and the excitation light coupling unit 606 receive light from a light emitting diode (LED) or a laser light source, respectively, and an irradiation light connection unit 600 and an excitation light connection unit (not shown). To join. One embodiment employs two white LEDs as illumination light sources. Also shown in FIG. 10 is a key slot 585 that can prevent the connector 540 from being connected to the receptacle 532 in an incorrect orientation.

  FIG. 11 is a cross-sectional view of the module shown in FIGS. 9 and 10. The cross section is taken along line 11-11 'in FIG. 10, which shows laser energy coupling portion 561, feedback coupling portion 616, and spray water coupling portion 591. The water source 620 can supply water to the spray water coupling portion 591.

  FIG. 12 is another cross-sectional view of the module shown in FIGS. 9 and 10. The cross section of FIG. 12 is taken along line 12-12 'of FIG. This figure shows a cross section of a light source (eg, LED 640) that can supply light to one or both of the illumination light coupling portion 601 (FIG. 10) and the excitation light coupling portion 606, for example. The air shutter 625 controls the position of the radiation filter 630 located in the laser base unit 530 (FIG. 7) so that the filter is inserted into or removed from the light path from the light source (eg, LED 640). You can make it. For example, one or more air shutter filters are provided to enable switching between blue and white light coupled to the illumination light coupling unit 601 and the excitation light coupling unit 606, for excitation and visualization. Can be increased.

  FIG. 13 is a drawing of an embodiment of the conduit 535 shown in FIG. The illustrated embodiment of conduit 535 includes a plurality of proximal members, such as four proximal members including a first proximal member 536, a second proximal member 537, a third proximal member 538, and a fourth proximal member 539. Includes members. The first, second, and third proximal members 536, 537, and 538 can have a hollow interior that is less than the cross-sectional area of the hollow interior of one or more optical transmitters or conduits. It is configured to receive other tubular or elongated structures having an area. According to one embodiment, the first proximal member 536 includes an illumination fiber, the second proximal member 537 includes an excitation fiber, and the third proximal member 538 includes a feedback fiber. The first, second, and third proximal members 536, 537, and 538 can be arranged such that the hollow interior of each proximal member communicates with the hollow interior of the elongated body 522 (FIG. 7). . This arrangement provides a substantially continuous path for the optical transmitter to extend from the proximal portion 521 to the distal portion 550 of the laser handpiece 520 (FIG. 7). The third proximal member 538 can receive feedback (eg, reflected or scattered light) from the laser handpiece 520 and send feedback to the laser base unit 530, which will be more specifically described below. .

  The fourth proximal member 539 can include a laser energy fiber that receives laser energy derived from an Er, Cr: YSGG solid state laser disposed within the laser base unit 530 (FIG. 7). The laser can produce laser energy having a wavelength of approximately 2.78 microns with an average power of about 6 W, a repetition rate of about 20 Hz, and a pulse width of about 150 milliseconds. Also, the laser energy can further include an aiming beam such as light having a wavelength of about 655 nm and an average power of about 1 mW transmitted in a continuous wave (CW) mode. The fourth proximal member 539 can be coupled to or include a treatment optical fiber 565 (FIG. 8) that receives laser energy from the laser energy coupling portion 561 (FIG. 10). The fourth proximal member 539 can further deliver laser energy received from the laser base unit 530 to the distal portion 550 of the laser handpiece 520 (FIG. 7). According to the present invention, the fourth proximal member can receive integrated electromagnetic energy from multiple laser sources. The laser sources may be the same, or broadly different in modified embodiments.

  Although the illustrated embodiment is provided with four proximal members, a greater or lesser number of proximal members may be added to additional embodiments, for example, depending on the number of optical transmitters provided by the laser base unit 530. Can be given. Further, the illustrated embodiment has a diameter that is smaller than any of the diameters of the first and second proximal members 536 and 537 having substantially equal diameters and the first and second proximal members 536 and 537. A third proximal member 538. Other diameter configurations can also be envisaged by the present invention. In the exemplary embodiment, the proximal member connects with a connection in connector 540 shown in FIG. For example, the first proximal member 536 can be connected to the illumination light connection 600, and the second proximal member 536 can be connected to an excitation light connection (not shown). The third proximal member 538 can be connected to the feedback connection 615 and the fourth proximal member can be connected to the laser beam delivery guide connection 560 and the treatment optical fiber 565. Attachment of the proximal members 536-539 to the connection can be done inside the connector 540 in a manner known or apparent to those skilled in the art in view of the present disclosure and is not shown in FIGS. .

  FIG. 14 is a cutaway view of a portion of the handpiece tip 545 (see FIG. 7) that couples to the laser base unit 530 by the link element 525 and the elongated portion 522 of the laser handpiece 520. The illustrated embodiment surrounded by the outer surface 546 can receive electromagnetic (eg, laser) energy, illumination light, excitation light, etc. from the laser base unit 530. Typically, laser energy and light are received by the proximal members 536-539 (FIG. 13) as described above and placed within the elongate portion 522 and handpiece tip 545 described below with respect to FIG. Sent through a waveguide, such as fiber 705. According to one embodiment, laser energy 701 is received (eg, through fourth proximal member 539 (FIG. 13)) and carried by an internal waveguide, such as treatment optical fiber 700, and handpiece tip 545. Is directed toward a first mirror 720 disposed within the distal portion 550 of the laser, and reflected laser energy is directed therefrom toward a fiber tip 555. A fiber tip 555 that can be configured (eg, sized and shaped) for integrated output or standard operation is housed in a tip ferrule 605 and the fiber tip. 555, a removable compatible unit, which was filed on September 19, 2005, titled OUTPUT ATTACHMENTS CODE FOR FOR USE WITH ELECTROMAGNETIC-ENERGY PROCEDURAL DEVICE (Attorney Docket Number BI9804P) Of U.S. Patent Application Serial No. 11 / 231,306, the entire contents of which are hereby incorporated by reference to the extent they do not contradict each other.

  For example, illumination light (not shown), such as from proximal members 536 and 537 (FIG. 13), can also be received by handpiece tip 545 and fiber 705 (FIG. 16, not shown in FIG. 14). And is directed toward a second mirror 725 disposed in the distal portion 550 of the handpiece tip 545 as well. The second mirror 725 directs light in the direction of the plurality of tip waveguides 730, which is described more specifically below with respect to FIG. The light exiting the distal waveguide 730 can illuminate the target area. In some embodiments, the first and second mirrors 720 and 725 can include parabolic, annular, and / or flat surfaces. FIG. 14 further shows a simplified view of the cooling air path 745.

  FIG. 15 is a cross-sectional view of the first proximal member 536 taken along line 15-15 ′ of FIG. 13 and includes a first proximal member 536 (and optionally a second proximal member 537). ) May include three optical fibers 705 that are substantially melted together to define a single light emitting assembly or waveguide. In modified embodiments, the three optical fibers 705 may or may not be joined by other means. According to other embodiments, one or more of the proximal members, such as the second proximal member 537, can include a different number of optical fibers 705. In the illustrated embodiment, the second proximal member 537 begins to separate, as shown in the cross-sectional view of FIG. 16 taken along line 16-16 ′ of FIG. Eventually (eg, at line 16-16 ′ in FIG. 14), six optical fibers 705 (FIG. 15) may be included that surround a laser energy waveguide, such as treatment optical fiber 700. In another exemplary embodiment, the second proximal member 537 can include three optical fibers 705 (FIG. 15) and the first proximal member 536 includes three optical fibers 705 (FIG. 15). All six of these can begin to separate and eventually (eg, at line 16-16 ′ in FIG. 14) a laser energy waveguide, such as a treatment optical fiber 700, at the handpiece tip 545. surround.

  The third proximal member 538 can similarly include six relatively small fibers 710, as shown in the cross-sectional view of FIG. Additional waveguides, such as additional fiber 710, can be placed in the outer surface 546 and can be configured to receive feedback from the target surface. For example, the feedback can include scattered light 735 (FIG. 14) received from the fiber tip 555 in a manner that is more specifically described below. Scattered light 735 (ie, feedback light) can be sent to the laser base unit 530 (FIG. 7) by the third proximal member 538 (FIG. 13). Although the fibers 710 are shown separated from each other in FIG. 16, in additional embodiments, two or more of the fibers 710 may be melted or otherwise joined together. Also good. Fibers 705 and 710 can be made from plastic using conventional techniques such as extrusion.

  FIG. 17 is a cross-sectional view of another embodiment of the handpiece tip 545, taken along line 16-16 'of FIG. FIG. 17 shows a laser energy waveguide, such as a therapeutic optical fiber 700, surrounded by an illuminating waveguide, such as fiber 705, and a feedback waveguide, such as fiber 710, all within outer surface 546. Placed in. In a manner similar to that described above with respect to FIG. 16, the illuminating waveguide, such as fiber 705, can illuminate the illuminating light coupling 601 (FIG. 4), the illuminating light connection 600 (FIG. 8), and, for example, proximal Members 536 and / or 537 (FIG. 13) can receive light energy from the laser base unit 530 and the fiber 705 can direct light to the distal portion 550 of the handpiece tip 545 (FIG. 14). .

  For example, in the United States under the title of CARIES DETECTION USING TIMING DIFFERENTIALS BETWEEN EXCITATION AND RETURN PULSES (Attorney Docket Number BI9805P) filed on August 12, 2005, the entire contents of which are incorporated herein by reference. In certain embodiments including caries detection disclosed in patent application serial number 11 / 203,399, the fiber 705 can further function as both an illumination waveguide and an excitation waveguide. A feedback waveguide, such as fiber 710, can receive feedback light from fiber tip 555 (FIG. 14) and sends feedback light to third proximal member 538 that couples to or includes feedback connection 615. be able to. The feedback light can be received by a feedback coupling 616 that sends light to a feedback detector 645 (FIG. 11) located in the laser base unit 530 (FIG. 7). Completely in accordance with pending US Patent Application Serial No. 11 / 192,334 filed July 27, 2005 and titled IDENTICAL CONNECTOR FOR A MEDICAL LASER HANDPIECE, described above. In other described embodiments, the laser base unit 530 may further supply atomizing air, atomizing water, and cooling air to the laser handpiece 520.

  18 is a cross-sectional view of another embodiment of the laser handpiece tip 545 taken along line 18-18 'of FIG. This embodiment shows a fiber tip 555 surrounded by a tip ferrule or sleeve 605, optionally filling the cavity 630 around the fiber tip with glue to place the fiber tip 555 in place. Hold. The tip waveguide 730 can receive the irradiation light from the second mirror 725 (FIG. 14) and direct the irradiation light to the target. In some embodiments, the fluid output 715 located at the handpiece tip 545 can carry air and water, for example. More specifically, the irradiation light emitted from the irradiation fiber 705 (see FIG. 17) is reflected by the second mirror 725 (FIG. 14) to the tip waveguide 730 (FIGS. 14 and 18). A portion of this illumination light can be further reflected by the second mirror 725 (FIG. 14) to the fiber tip 555, which is primarily the treatment optical fiber 700 (see FIG. 17). Receive a relatively high level of laser energy, which, as embodied herein, includes radiation including both a cutting beam and an aiming beam. In an exemplary embodiment, the illumination light from the fiber 705 exiting the tip waveguide 730 is white light of variable intensity (eg, adjustable by the user) and is a target such as a tooth. Allows viewing and close inspection of individual locations on the surface. For example, the tooth cavity can be closely examined and treated with the help of light from the plurality of tip waveguides 730.

  A detailed view of an embodiment of a chamber for mixing atomized air and atomized water within the handpiece tip 545 is shown in FIG. 14a. As shown, the mixing chamber includes, for example, an air intake 713 connected to a tube (not shown) and connects to and receives air from an air connection 595 in a connector 540 (FIG. 8). Similarly, the water intake 714 can be connected to a tube (not shown) to connect to the spray water connection 590 in the connector 540 (FIG. 8) and receive water therefrom. The air intake 713 and the water intake 714, which can have a circular cross section with a diameter of about 250 μm, join at an angle 712, which can be approximately 110 ° in a typical embodiment. Mixing can occur near the junction of the air intake 713 and the water intake 714, and a water and air spray (eg, atomized) mixture 716 can be discharged through the fluid outlet 715. . The embodiment shown in FIG. 18 shows three fluid outlets 715. These fluid outlets are, for example, those of the fluid outlet described in US patent application Ser. No. 11 / 042,824, filed Jan. 24, 2005, entitled ELECTROMAGNETICALLY INDUCED CUTTER AND METHOD. It may correspond to any part of, or may include substantially all, the contents of which are incorporated herein by reference to the extent they are compatible, or in other embodiments The structures described in the patent application can be modified to be compatible with the present invention. The fluid outlet 715 has a circular cross section measured at a diameter of about 350 μm, as shown in FIGS.

  The scattered light described above with respect to FIG. 13 can be detected and analyzed to monitor various conditions. For example, the scattering of the aiming beam can be detected and analyzed, and for example, the integrity of the optical components that send the cutting and aiming beams can be monitored. In a typical implementation, the aiming beam can cause little or no reflection on the feedback fiber 710. However, if any part is damaged (eg, mirror 720 or fiber tip 555), scattering of aiming beam light (which may be red in the exemplary embodiment) will occur. Can do. The scattered light 735 (FIG. 14) can be directed by the second mirror 725 to the feedback fiber 710 that can carry the scattered light to the laser base unit 530 (FIG. 7).

  The present invention can be mounted, for example, on (eg, attached) or near (eg, on or near the output end) an electromagnetic energy output device (eg, lasers and dental lasers). US Provisional Patent Application Serial No. 60 / 687,991, filed June 6, 2005, entitled ELECTROMAGNETIC RADIATION EMITTING TOOTHBRUTH AND DENTIFRICE SYSTEM (Attorney Docket No. BI9887PR), and Considering the configuration and application of the visual feedback tool described in METHODS FOR TREATING EYE CONDITIONS (Attorney Docket Number BI9879PR) filed on June 6, 2005, such output The arrangements, configurations, and applications are described or referred to herein or described herein by one of ordinary skill in the art, in whole or in part, to the extent they are not mutually exclusive. Or ELECTROMAGNETIC ENERGY DISTRIBUTIONS FOR ELECTROMAMAGETICALLY INDUCED DISCUPTING CITTING (substitute reference number BI9842P) filed on January 10, 2005 US patent application Ser. No. 11 / 033,032, filed Jan. 10, 2005, U.S. patent application Ser. No. 11 / 033,0, entitled TISSUE REMOVER AND METHOD (Attorney Docket Number BI9830P) No. 3, US patent application Ser. No. 11 / 203,400, filed Aug. 12, 2005, entitled DUAL PILSE-WIDTH MEDICAL LASER WITH PRESET (Attorney Docket No. BI9808OP), Aug. 12, 2005 US Patent Application No. 11/203 entitled LASER HANDPICE ARCHITECTURE AND METHODS, filed on May 1, 2001, and MATTOLOGICAL CUTING AND ABLATING DEVICE, filed May 2, 2001 All relevant methods, modifications, combinations, substitutions, and the like as described in US patent application Ser. No. 09 / 848,010 entitled All of which are incorporated herein by reference in their entirety. In some embodiments, a sensor can be introduced that can include one or more visual feedback systems. The implementation of the visual feedback system is, for example, (a) in the form integrated in the output end of the handpiece or electromagnetic energy output device, (b) in the form attached to the handpiece or electromagnetic energy output device, or (c ) Can be used in conjunction with (e.g., not attached to) a handpiece or electromagnetic energy output device, and such handpiece and device can allow cutting, excision, treatment, and the like. Broadly, the treatments of the modified embodiments include, for example, the above-cited US Provisional Patent Application No. 60 / 687,991, and 2005, the entire contents of which are expressly incorporated herein by reference. Integrated output or standard electromagnetic energy as described in US Provisional Patent Application No. 60 / 687,256, filed Jun. 3, entitled TISSUE TREATMENT DEVICE AND METHOD (Attorney Docket No. BI9846) Can include low level light therapy.

  For example, one implementation may be beneficial, among other things, to optimize, monitor or maximize the cutting effect of an electromagnetic energy emitting device such as a laser handpiece. The integrated laser output can be, for example, from a waveguide, such as an output fiber (eg, one optical fiber and / or output tip), fluid (eg, air) emitted from the fluid outlet of the handpiece onto the target surface. And / or atomized dispersion of water particles, fluid particles, or water particles near the output end of the handpiece and / or spray connections). A plurality of fluid outlets are disposed concentrically around the output fiber as described, for example, in US patent application Ser. No. 11 / 042,824 and US application Ser. No. 11 / 231,306, cited above. Fluid outlets. The output fiber can include, for example, a spread therapeutic optical fiber as described herein. A corresponding structure for directing electromagnetic energy to the atomized dispersion of fluid particles on the target surface is disclosed, for example, in US Pat. No. 5,574,247. A large amount of laser energy can be imparted to a fluid (eg, atomized fluid particles) that can include, for example, water, thus spreading the fluid (eg, fluid particles) and destructive (eg, A mechanical cutting force can be applied to the target surface. In the case of an integrated output mode of operation, the size of the interaction area (eg, area or volume) is the same analysis given above for having an enlarged spot size in the integrated output mode. Can be increased. Thus, for example, the cross-sectional diameter of a relatively large spot size measured transverse to the direction of propagation of the integrated electromagnetic energy projected onto the interaction area is the reference spot size associated with the previous configured electromagnetic energy emitting device. Can be larger. In one example, the relatively large spot size can be about 1.1 to 2 times the reference spot size (eg, for two or more integrated treatment beams) , The relatively large spot size may be twice as large as the spot size associated with the pre-configured electromagnetic energy emitting device (eg, for an integrated beam from two treatment beams). A relatively large spot size corresponds to or equal to the reference fluence or power density of a single electromagnetic energy emitting device performing treatment in an isolated or non-integrated mode of operation, or It can be selected to have a power density. During processes such as oral procedures with limited access and visibility, (a) interaction between electromagnetic energy and fluid (eg, on the target surface) and / or (b) failure surface against the target surface. Careful and close monitoring by performing visual feedback of cutting, excision, treatment, or other application can improve the quality of the procedure.

  In certain embodiments, the distal portion 550 of the laser handpiece 520 (FIG. 7) is used to guide an image (eg, a working surface image) acquired at or near the distal portion by performing visual feedback. A visualization optical fiber (e.g., a coherent fiber bundle) configured to send light from to the proximal portion 521 can be provided. According to some embodiments, performing visual feedback can include an image acquisition device (such as a CCD or CMOS camera) to acquire or process images from the distal portion. The implementation of visual feedback can be built in or attached (eg, removably attached) to the handpiece, and can also be placed at various locations on the handpiece between the proximal and distal portions. Or may be located in association with the handpiece or may be located proximal to the proximal portion. According to any of the present embodiments and other embodiments described herein, one or more of the optical fibers and visual optical fibers described herein can be, for example, outside of a handpiece container. You may arrange in. Some applications for the implementation of the visual feedback described herein include periodontal pockets (eg, diagnosis and treatment) as described in US Provisional Patent Application No. 60 / 688,109, cited above. , Endodontic therapy (eg, tube visualization), micro dentistry, tunnel preparation, caries detection and treatment, bacterial visualization and treatment, general dentistry, and airborne matter and gas detection applications.

  According to another embodiment of the present invention, electromagnetic radiation (such as one or more of blue light, white light, infrared light, laser beam, reflected / scattered light, fluorescence, etc. in any combination) is In any combination, one or both methods can be routed through one or more of the fibers described herein (eg, feedback, irradiation, excitation, treatment, etc.). The outgoing and incoming beams of electromagnetic radiation are transmitted in the proximal portion of the laser base unit using a beam splitter such as a wavelength selective beam splitter (not shown), for example, by methods known to those skilled in the art. , Can be separated or divided by one or more of its features.

  In the exemplary embodiment, fluid outlets 715 (FIG. 18) are spaced at zero degrees (first reference), 125 degrees, and 240 degrees. In another embodiment, six illumination / excitation fibers 705 and three feedback fibers 710 (FIG. 7) are optically aligned on nine tip waveguides 730, eg, one-to-one, They are coupled by two mirrors 725 (FIGS. 14 and 18). For example, nine elements (eg, six illumination / excitation fibers 705 and three feedback fibers 710) may be zero degrees (second reference, which may be the same as or different from the first reference). 9 tip waveguides 730 when spaced apart at 40 degrees, 80 degrees, 120 degrees, 160 degrees, 200 degrees, 240 degrees, 280 degrees, and 320 degrees. Are equally spaced apart at zero degrees, 40 degrees, 80 degrees, 120 degrees, 160 degrees, 200 degrees, 240 degrees, 280 degrees, and 320 degrees. For example, in another embodiment where the tip waveguides 730 are arranged in relatively closely spaced groups, each arranged between two fluid outlets, the tip waveguides 730 are: For example, it can be arranged at zero degrees, 35 degrees, 70 degrees, 120 degrees, 155 degrees, 190 degrees, 240 degrees, 275 degrees, and 310 degrees. In such embodiments, the tip waveguide 730 can be similarly positioned at zero degrees, 35 degrees, 70 degrees, 120 degrees, 155 degrees, 190 degrees, 240 degrees, 275 degrees, and 310 degrees. Further, in such embodiments, the fluid outlets can be disposed between the group of tip waveguides at about 95 degrees, 215 degrees, and 335 degrees.

  The cross-sectional views of FIGS. 16 and 17, or (or in addition), reveal corresponding structures that output radiation distally on the first mirror 720 and the second mirror 725 without being altered. In order to do so, it can correspond to the transverse line 16-16 ′ of FIG. 14 in close proximity to (or adjacent to) the first mirror 720 and the second mirror 725. The diameters of the illumination / excitation fiber 705 and the feedback fiber 710 may be different from those shown in FIG. 16, or these diameters may be the same as those shown in FIG. In the exemplary embodiment, illumination / excitation fiber 705 and feedback fiber 710 in FIG. 17 include a plastic configuration with a diameter of about 1 mm, and tip waveguide 730 in FIGS. 14 and 18 has a diameter of about 0.9 mm. Includes sapphire configuration.

  The disclosure herein has described a handpiece that uses integrated electromagnetic energy to affect a target surface. In the case of a dental procedure using integrated laser energy, the handpiece includes an optical fiber for delivering integrated laser energy to the target surface to treat (eg, ablate) a dental structure such as a tooth, and tooth irradiation. A plurality of optical fibers that send light (eg, blue light) for curing, whitening, and / or diagnosis; and a plurality of optical fibers that send light (eg, white light) to the teeth to provide illumination of the target surface; And a plurality of optical fibers that send the light from the target surface back to the sensor for analysis. In the illustrated embodiment, the optical fiber that transmits blue light also transmits white light. According to one aspect of the invention disclosed herein, the handpiece includes an illumination tube having a feedback signal end and a double mirror handpiece.

User Manual for a WATERLASE® ALL-Tissue Laser for Denstry (herein referred to as “incorporated WATERLASE® User Manual”), the entire contents of which are incorporated herein by reference. According to one aspect of the invention outlined, it includes programmed parameter values, referred to herein as presets, that are applicable to a variety of surgical procedures. The preset can be programmed at the time of manufacture of the device, in which case the preset can be referred to as a pre-programmed preset. Alternatively or in addition, the end user can create or modify a preset and store it. Incorporated WATERLASE® User Manual Table 2 is reproduced herein as Table 1 and includes examples of pre-programmed presets for general hard and soft tissue treatments.

Table 1 Proposed presets for general hard and soft tissue procedures

  Referring to Table 1, any of the parameter combinations listed, or variations thereof, can be implemented by any of the integrated output implementations described herein. In a simple exemplary implementation, presets 1 through 4 were formed from two treatment beams and a spot size that was enlarged 1.1 or more times (eg, twice) of the corresponding reference spot size. For example, the fluence or power density may be the same as the reference fluence or power density. The percentage air and percentage water settings given here are pressures ranging from about 5 pounds per square inch (psi) to about 60 psi, and from about 0.5 liters / minute to about 20 liters / minute. A range of flow rates can be directed to one or more fluid outlets (see FIGS. 14, 14a, and 715 of FIG. 18). The liquid (eg, water) is one or more of the fluid outlets 380 at a pressure ranging from about 5 psi to about 60 psi and a flow rate ranging from about 2 milliliters (ml) / min to about 100 ml / min. Can be directed to. In other embodiments, the air flow rate can be as low as about 0.001 liter / min and / or the liquid flow rate can be as low as about 0.001 ml / min. In a particular implementation, the water flow rate through the water line located in the laser handpiece 520 (FIG. 7) can be about 84 ml / min (eg, 100%) and the air line of the laser handpiece 529 is The air flow rate through may be about 13 liters / minute (eg, 100%). These values can be understood by referring to these flow rates and the incorporated WATERLACE® User Manual, or other flow rates suggested in the same context to those known to those skilled in the art. it can.

  In an exemplary embodiment of an integrated output system, the electromagnetic energy emitting device forming the integrated output system has a given setting for a given application or procedure, eg, as described above with respect to Table 1. The diameter of the waveguide is typically used when the device is used individually in a non-integrated mode and is configured according to a given setting for a given application or treatment. It can be larger than the diameter of the waveguide used in conjunction with the device. In other words, the diameter of the waveguide carrying the integrated beam of the integrated output system is individually operated in substantially the same setting and / or the same application as when operated as part of the integrated output system. Or it can be larger than the diameter used for the device (ie, the pre-configured electromagnetic energy emitting device that forms the integrated output system) when used to perform the procedure.

  In certain embodiments, the methods and apparatus of the above-described embodiments are to be used to the extent that they are compatible with and / or not mutually exclusive with existing technologies including any of the apparatus and methods described above. Can be configured and implemented. BioLase Technology, Inc. The corresponding or related structures and methods described in the following patents assigned to, are hereby incorporated by reference in their entirety, and such incorporation is incorporated herein by reference: And can be made operable according to knowledge and judgment (i) of those skilled in the art, can be modified by those skilled in the art to be operable according to (ii), and / or in conjunction with (iii) or US Patent No. 6,829,427, ELECTROMAGNETIC ENERGY DISTRIBUTIONS FOR ELECTROLOGICAL INDUCEDLY INDUSTRY, FIBER DETECTOR APPARATUS ANDRELATED METHODS, which can be implemented / used in combination with any part US Patent No. 6,821,272 entitled TING, US Patent No. 6,744,790 entitled DEVICE FOR REDUCTION OF THERMAL LENSING, U.S. Patent No. 6,669, entitled TISSUE REMOVER AND METHOD U.S. Pat. US Pat. No. 6,610,053 entitled ETICALLY INDUCED CUTTING, US Pat. No. 6,567,582 entitled FIBER TIP FLUID OUTPUT DEVICE, US Pat. No. 6,561,803 entitled FLUID CONDITIONING SYSTEM U.S. Pat. US Patent No. 6,389,193 entitled ROTATING HANDPIECE, US Patent No. 6,350,123 entitled FLUID CONDITIONING SYSTEM , 288, 499, U.S. Patent No. 6,254,597 entitled TISSUE REMOVER AND METHOD, U.S. Patent No. 6,231,567 entitled MATERIAL REMOVER AND METHOD, DENTAL AND MEDICAL PROCEDURES EMPLOY. US Patent No. 6,086,367 entitled NG LASER RADIATION, USER PROGRAMMABLE COMNATION OF OF ATOMIZED PARTICLES FOR ELECTROMAGNETICAL INDUCED CUTTING US Patent No. In patents such as US Pat. No. 5,741,247 entitled ATOMIZED FLUID PARTICLES FOR ELECTROMAGNETICALLY INDUCED CUTING, in US Pat. No. 5,741,247, including (and modifications thereof) All these are books Which is assigned to the light of the assignee, the entire contents of which are incorporated herein by reference.

  Further, the above disclosure is a provisional patent application entitled FIBER TIP DETECTOR APPARATUS, filed July 13, 2004, filed July 13, 2004, all assigned to the assignee of the present invention. Tentative patent application titled CONTRA-ANGLE ROTATING HANDPICE HAVING TACTILE-FEEDBACK TIP FERRULE And a provisional patent application titled, and filed on August 12, 2004 In the provisional patent application ER, which is a U.S. registered under the trademark U.S. under the trademark U.S. under the trademark U.S.A. Intended. The entire contents of the above materials are incorporated herein by reference.

  Although the invention has been described with reference to various specific examples and embodiments, it is to be understood that the invention is not limited thereto and can be implemented in a variety of ways. Numerous variations, combinations, and modifications to the disclosed embodiments will occur to those skilled in the art to the extent that the above discussion considerations are not mutually exclusive. Furthermore, other combinations, omissions, substitutions, and modifications will be apparent to those skilled in the art from the disclosure herein. Accordingly, the invention is not intended to be limited by the disclosed embodiments, but is to be defined by reference to the appended claims.

1 is a prior art electromagnetic energy release device. 1 is a drawing of one embodiment of an electromagnetic energy emitting device with increased spot size according to the present invention. FIG. FIG. 6 is a drawing of a modified embodiment of the present invention. FIG. 6 is a drawing of an embodiment of the present invention integrating the therapeutic energy outputs of five electromagnetic energy sources. FIG. 2 shows two possible parts of an integrated device. FIG. 4 is a drawing of an embodiment in which the outputs of four electromagnetic energy sources can be integrated. FIG. 5C is a portion of the embodiment of FIG. 5B illustrating the use of defocusing optics to obtain an increased spot size. FIG. 3 is a flow diagram of an implementation of a method for increasing the size of an area of interest according to the present invention. 1 is a drawing of a delivery system capable of transmitting electromagnetic energy to a treatment site according to an example of the present invention. FIG. It is a drawing figure which shows the detail of the connector by the example of this invention. FIG. 9 is a perspective view of an embodiment of a module that can be connected to a laser base unit and can receive the connector shown in FIG. FIG. 10 is a front view of the embodiment of the module shown in FIG. 9. FIG. 11 is a cross-sectional view of the module shown in FIG. 10 taken along line 11-11 'of FIG. 12 is a cross-sectional view of the module shown in FIG. 10 taken along line 12-12 'of FIG. FIG. 8 is a drawing of the embodiment of the same feeling shown in FIG. 7. It is the figure which notched some handpiece front-end | tip parts by the example of this invention. FIG. 15 is a detailed drawing of the handpiece tip of FIG. 14 showing a mixing chamber for atomizing air and water. FIG. 14 is a cross-sectional view of the proximal member of FIG. 13 taken along line 15-15 'of FIG. FIG. 17 is a cross-sectional view of the handpiece tip taken along line 16-16 'of FIG. FIG. 17 is a cross-sectional view of another embodiment of the handpiece tip taken along line 16-16 'of FIG. FIG. 19 is a cross-sectional view of an implementation of the embodiment of the handpiece tip taken along line 18-18 'of FIG.

Claims (23)

A method for increasing the spot size projected onto or onto a target by an electromagnetic energy emitting device, comprising:
Providing a plurality of therapeutic electromagnetic energies, each of which can irradiate the target with therapeutic electromagnetic energy having a reference power density and a reference spot size;
Integrating the plurality of therapeutic electromagnetic energies to form integrated electromagnetic energy on or in the target;
The integrated electromagnetic energy has a power density that is approximately the same as the maximum of the corresponding reference power density and has a spot size that is larger than the maximum of the corresponding reference spot size,
A method characterized by that.   The method of claim 1, wherein the integrating step includes directing the therapeutic electromagnetic energy to an integrated device, and an output therefrom includes the integrated electromagnetic energy.   The method of claim 1, wherein the integrating step includes directing the therapeutic electromagnetic energy to an optical component capable of producing an output that includes the integrated electromagnetic energy.   4. The method of claim 3, wherein the step of directing includes directing the integrated energy toward a waveguide, the waveguide directing the integrated electromagnetic energy toward the target.   The method of claim 3, wherein the directing step does not include the use of a waveguide. The integrating step includes directing the therapeutic electromagnetic energy to an input of a plurality of first waveguides having a reference cross-sectional area;
The output of the plurality of first waveguides is less than the number of the plurality of first waveguides, but the cross-sectional area is directed to one or more second waveguides that are larger,
The method of claim 1, wherein an output of the one or more second waveguides includes the integrated electromagnetic energy. Directing the therapeutic electromagnetic energy comprises directing therapeutic electromagnetic energy emitted by two electromagnetic energy emitting devices;
The plurality of first waveguides include two waveguides;
The one or more second waveguides include one waveguide having a cross-sectional area that is approximately twice the largest corresponding cross-sectional area of the plurality of first waveguides. The method of claim 6. Directing the therapeutic electromagnetic energy includes directing therapeutic electromagnetic energy emitted by three electromagnetic energy emitting devices;
The plurality of first waveguides includes three waveguides;
The one or more second waveguides include one or two waveguides each having a cross-sectional area greater than a maximum corresponding cross-sectional area of the plurality of first waveguides. The method according to claim 6. An apparatus for increasing the spot size projected onto or onto a target by an electromagnetic energy emitting device,
A plurality of therapeutic electromagnetic energy outputs, each capable of illuminating the target with therapeutic electromagnetic energy having a reference power density and a reference spot size;
An integrated device capable of integrating the therapeutic electromagnetic energy emitted by the plurality of electromagnetic energy output units to form integrated electromagnetic energy on or on the target;
The integrated electromagnetic energy has a power density that is approximately the same as a maximum of a corresponding reference power density and has a spot size that is larger than a maximum of a corresponding reference spot size,
A device characterized by that. The integrated device is
A plurality of waveguide inputs capable of receiving therapeutic electromagnetic energy from the plurality of electromagnetic energy outputs;
10. The apparatus of claim 9, including at least one waveguide output that can carry the integrated electromagnetic energy to the target. The plurality of electromagnetic energy output units includes two electromagnetic energy output units,
The plurality of waveguide output portions include two waveguide output portions,
11. The apparatus of claim 10, wherein the at least one waveguide output includes a waveguide output.   12. The apparatus of claim 11, wherein the spot size is approximately twice as large as the largest of the corresponding reference spot sizes. The two electromagnetic energy output units are a first electromagnetic energy output unit and a second electromagnetic energy output unit,
The first electromagnetic energy output unit emits therapeutic electromagnetic energy having a first wavelength effective for ablating hard tissue;
12. The apparatus of claim 11, wherein the second electromagnetic energy output unit emits a second wavelength that is different from the first wavelength, but has substantially the same efficacy for ablating hard tissue.   Each of the first wavelength and the second wavelength comprises an A wavelength ranging from about 2.70 to about 2.80 microns, a B wavelength of about 2.69 microns, and a C wavelength of about 2.94 microns. 14. The device of claim 13, wherein the device is selected from the group consisting of: The two electromagnetic energy output units are a first electromagnetic energy emission output unit and a second electromagnetic energy output unit,
The first electromagnetic energy output unit emits therapeutic electromagnetic energy having a first wavelength;
The second electromagnetic energy output unit emits therapeutic electromagnetic energy having a second wavelength;
The apparatus of claim 13, wherein the first wavelength is approximately equal to the second wavelength.   The apparatus of claim 9, wherein the integrated device includes an optical component capable of receiving therapeutic electromagnetic energy from the plurality of electromagnetic energy outputs.   The apparatus according to claim 9, wherein the electromagnetic energy output unit is a laser output unit, the therapeutic electromagnetic energy is therapeutic laser light, and the integrated electromagnetic energy is integrated laser light. The integrated device is
A plurality of waveguide inputs capable of receiving therapeutic laser beams from the plurality of laser outputs;
At least one waveguide output capable of directing the integrated laser to the target;
The apparatus of claim 17, comprising: The plurality of laser output units includes two laser output units,
The apparatus of claim 17, wherein the at least one integrated laser beam comprises a single integrated laser beam. The integrated device includes an optical component capable of receiving laser beams from the two laser output units,
The apparatus of claim 19, wherein the optical component directs the integrated laser beam to an input waveguide. The plurality of laser output units includes three laser output units,
The apparatus of claim 17, wherein the at least one integrated laser beam comprises one or two integrated laser beams. The integrated device includes an optical component capable of receiving laser beams from the three laser output units,
The apparatus of claim 21, wherein the optical component directs the one or two integrated laser beams to one or two input waveguides. The plurality of laser output units are:
A first laser output that emits treatment laser light having a first wavelength;
18. The apparatus of claim 17, further comprising a second laser output that emits therapeutic laser light having a second wavelength that is substantially the same as the first wavelength.

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